History of the Medical Home Concept

“Every child deserves a medical home” is one of the American Academy of Pediatrics’ (AAP) essential child health outcomes for the 21st century. With increasing health care costs, technology, survivorship, specialization, and fragmentation of care, the medical home is steadily gaining interest and standing in the public eye. Today’s policy makers, those who are involved with children, and parents are increasingly using the term to describe the concept as the form of high-quality health care. With so much attention focused on this concept as the standard of care for all infants, children, adolescents, young adults, and particularly children with special health care needs (CSHCN), it is important to define this term and how its definition has evolved. Whereas the term was originally used to describe a place—a single source of all medical information about a patient—the term now refers to a partnership approach with families to provide primary health care that is accessible, family centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.1 The first known documentation of the term “medical home” appeared in Standards of Child Health Care, a book published by the AAP in 1967 and written by the AAP Council on Pediatric Practice (COPP). The book defines a medical home as one central source of a child’s pediatric records and emphasizes the importance of centralized medical records to CSHCN. “For children with chronic diseases or disabling conditions, the lack of a complete record and a ‘medical home’ is a major deterrent to adequate health supervision. Wherever the child is cared for, the question should be asked, ‘Where is the child’s medical home?’ and any pertinent information should be transmitted to that place” (pp 77–79).2 The COPP, noting that care for CSHCN is often provided by many different practitioners who work in disparate locations independent of each … Reprint requests to (C.S.) 656 Paikau St, Honolulu, HI 96816-4406. E-mail: Calsia{at}pol.net